Most people don’t consider problems with oral health to be related to health conditions in other bodily areas.  However, having poor oral health can increase the risk of developing certain chronic conditions, and might also play a role in the development of autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis.  Of course I’m not suggesting that most cases of thyroid autoimmunity are caused by poor oral health, but this is a factor that is overlooked by most people, yet should be considered.  Fortunately more and more healthcare professionals are realizing that mercury amalgams can cause problems, and some also are aware of the potential risk factors of root canals.

It should make sense when you think about the connection between oral health and the rest of the body.  This is especially true with mercury amalgams, as many people reading this are aware of the risks of these, and it’s not uncommon for me to speak with a patient who has gotten all of their silver fillings replaced.  However, many people don’t make a similar connection with root canals and other health conditions.  Part of this has to do with the approach of most dentists, as while many dental clinics are avoiding the use of mercury amalgams, most still perform root canals on a frequent basis.  In addition, while there are tests which measure the amount of mercury in the tissues, which in turn can be linked to mercury amalgams, there isn’t a reliable test to see if a root canal is causing any health issues.

Is Mercury The Cause Of Your Autoimmune Thyroid Condition?

Before talking about root canals, let’s go ahead and briefly talk about the impact of mercury.  First of all, there is no doubt that having mercury amalgams results in the release of mercury vapors during the act of chewing.  What’s controversial is the effect that the mercury vapors have on our health, and whether this can serve as a trigger for thyroid autoimmunity, as well as other health conditions.  While some studies show that there is no relationship between dental amalgams and Hashimoto’s Thyroiditis (1), other studies have shown that the removal of dental amalgam decreases TPO and thyroglobulin antibodies in patients with autoimmune thyroiditis (2).  I’ll expand on this shortly.  Both the FDA and Centers for Disease Control (CDC) consider mercury amalgams to be safe in most cases.  On the other hand, the World Health Organization (WHO) considers mercury to be one of the top ten chemicals of major public health concern, and mentions how exposure to mercury, even in small amounts, may cause serious health problems (3).

I briefly spoke about the possible relationship between mercury and thyroid health earlier, and would like to expand on this, as there are numerous studies which demonstrate a negative effect of mercury on thyroid health.  Keep in mind that not all of these studies involve inorganic mercury, which is the mercury found in dental amalgams.  Methylmercury is found in fish, and both inorganic mercury and methylmercury can negatively impact the thyroid gland.  One study looked at the role of environmental factors in autoimmune thyroiditis, and showed that replacement of dental amalgams in mercury-allergic subjects resulted in improvement of health in about 70% of patients, and in some cases lead to a normalization of anti-thyroid autoantibodies (4).  Another study looked at the relationship between mercury and thyroid autoantibodies, and showed that there is an association between mercury and thyroglobulin antibodies, but not thyroid peroxidase antibodies (5).  Thyroglobulin antibodies are found in those with Hashimoto’s Thyroiditis.  However, mercury also might play a role in the development of Graves’ Disease, as this autoimmune thyroid condition usually involves the presence of Th2 cytokines.  And I did come across a study which showed that mercury can potentially trigger or worsen Th2 cytokine production in humans (6).  Although these studies focus on the effects of mercury and the immune system, numerous studies have shown that mercury can also have a direct effect on the thyroid hormones (7) (8).

So does this mean that everyone who has mercury amalgams should get them removed?  This remains controversial, as while there is no question that mercury shouldn’t have been used as fillings in the first place by most dentists, sometimes getting them removed can do more harm than good.  In some cases removing these amalgams can exacerbate the autoimmune response of someone who has Graves’ Disease or Hashimoto’s Thyroiditis.  Anyone who is looking to get their mercury amalgams removed should hire a dentist who takes the proper precautions when removing them, such as a biological dentist.  You can find one of these dentists by visiting the website of the International Academy of Oral Medicine and Toxicology or International Academy of Biological Dentistry & Medicine.  Their respective websites are www.iaomt.org and www.iabdm.org.

What Is The Risk Of Having One Or More Root Canals?

While many people reading this are aware of the risks of mercury amalgams, many aren’t aware of the potential risks of root canals.  Although the American Dental Association claims that root canals are safe simply because there is no scientific evidence which show them to be harmful, there also aren’t any scientific studies which show that root canals are completely safe.  Just to let you know, the ADA still considers mercury amalgams to be safe.  Without question this is a controversial topic, as while there are many people who have had their health improve upon removing their root canals, until there are numerous scientific studies which show this then most dentists will continue to recommend this procedure to their patients.

Before talking about the potential risks of root canals it probably would be a good idea to briefly explain what a root canal entails.  First of all, a root canal is usually recommended when the nerve of the tooth becomes infected or the pulp becomes damaged.  I’m not going to get into the details of the procedure, as you can find this information online, but essentially they will drill a hole into the tooth and remove the dental pulp, the decayed nerve tissue, and they will try their best to sterilize the area in order to kill the bacteria.  Once this has been accomplished the tooth will be sealed, and often times a crown will be placed over the tooth.

I left out a number of details, but the main controversy is whether all of the bacteria can successfully be eradicated.  In other words, can the canals be permanently sterilized?  Many reading this are familiar with Dr. Weston Price, who was a dentist who looked at the relationship between dental health and nutrition, and how it impacted our overall health.  Dr. Price took one thousand extracted teeth and sterilized the canals with forty different chemicals in order to see if permanent sterilization could be achieved.  After 48 hours he broke the teeth apart and cultured them, and found that all but one of the teeth had bacteria.  Other biological dentists have confirmed Dr. Price’s findings.

Although there aren’t any research studies I’m aware of which show a correlation between root canals and specific health conditions, there have been numerous people with different health conditions whose health improved dramatically upon removing their root canals.  In fact, in the article I just mentioned, Dr. Price stated that “the bacteria in root canals favor destruction of the nervous system and many other systems, resulting in the creation of autoimmune reactions”.  While a root canal isn’t the trigger for most autoimmune thyroid conditions, if someone who is following a natural treatment protocol has one or more root canals and doesn’t see an improvement in their health, then they might want to consider having these removed.

Should You Have Your Root Canals Removed?

If you have mercury amalgams and root canals and were to visit a biological dentist, there is an excellent chance they would advise you to replace your silver fillings.  There is also a pretty good chance they would recommend to remove any root canals you have as well.  This admittedly is a tough decision to make in some cases.  A few years ago I had a cavity in the back of my mouth that was between my teeth.  While I felt some discomfort at times, none of the dentists were able to spot it on the on the dental x-rays.  And by the time one of the dentists discovered the cavity it was too late.  Because it was towards the back of my mouth I decided I didn’t want a root canal, and I decided to get an extraction.

However, the decision isn’t as easy if someone needs to get a root canal in the front of their mouth.  If one needs a root canal in one of their front teeth and they choose to get an extraction, it probably is a good idea to get this replaced.  Truth to be told, it might also be a good idea to get it replaced if it’s towards the back of the mouth, but it’s arguably even more important to get some type of replacement for an extracted tooth in the front of the mouth.  The two options usually given are bridges and dental implants.  And there are pros and cons with each of these.

A dental bridge involves a non-removable prosthesis which is attached to the surrounding teeth.  The problem with these is that the healthy teeth surrounding the replacement tooth will usually need to be filed.  With regards to dental implants, many people receive these and seem to do fine.  However, there are a few drawbacks.  First, they are very expensive, and if someone doesn’t have dental insurance then they will be spending thousands of dollars on this.  Second, it’s an extensive procedure that will take months to complete.  And finally, most dental implants are made out of titanium, and while many people do fine with these implants, some people will react to titanium.

As a result, if someone currently has a root canal on a tooth that is towards the back of the mouth it might be best to get it extracted and not get a bridge or implant.  On the other hand, if someone has one or more root canals in the front or side teeth, then the decision to get the tooth removed can be more difficult.  Obviously the decision is ultimately up to the person, but regardless of where the root canal is, it probably would be a good idea to seek the opinion of a biological dentist to discuss the different options you have.  After all, while I have experience working with a biological dentist, and have read articles and watched videos conducted by biological dentists who spoke about root canals, I’m of course not a dentist.  And while this doesn’t prevent me from giving my opinion when someone asks about mercury amalgams or root canals, in many cases it is wise to speak with a biological dentist about this.

So hopefully you have a better understanding about the potential risks of dental amalgams and root canals.  A few different studies have shown that mercury can have a negative effect on thyroid health, as it can affect both the immune system, thus causing an increase in thyroid autoantibodies, and it can also have a direct effect on thyroid health.  As for root canals, although there aren’t any scientific studies which show that they are harmful, there also is no proof that they are safe.  And there have been many people with different health conditions who experienced a dramatic improvement in their health upon removing one or more root canals.  Does this mean that everyone with mercury amalgams and root canals should have them removed?  This remains controversial, and while there is no question that many people with thyroid and autoimmune thyroid conditions can benefit from getting these removed, it probably is best to consult with a biological dentist about this.

Many people who have an autoimmune condition follow an autoimmune paleo diet.  This is similar to a “standard” paleo diet, with a few additional restrictions.  While a standard paleo diet allows the consumption of eggs, nuts and seeds, along with the nightshade vegetables, an autoimmune paleo diet excludes these foods.  So essentially the person is allowed to eat meat, fish, vegetables, fruits, certain coconut products, and some spices.  But is this the ideal diet for everyone with Graves’ Disease and Hashimoto’s Thyroiditis?

Before answering this question I’d first like to talk in greater detail about the similarities and differences between a “standard” paleo diet and an autoimmune paleo diet.  Here are the main foods which are allowed on a standard paleo diet:

• Meat (beef, pork, chicken, lamb, etc.) and fish
• Eggs
• Fruits
• Vegetables (including the nightshades)
• Nuts and seeds

Foods which are excluded in a “standard” paleo diet include all grains, legumes, and dairy products.  And of course anything refined should also be avoided.  A standard paleo diet is restrictive with regards to what foods you can eat, although keep in mind that it is nutrient dense, and the goal isn’t to restrict calories.  As a result, while some people do struggle initially to follow a paleo diet, after awhile many of these people do perfectly fine and wish they had followed this sooner.  Many people do better upon avoiding the grains, legumes, and dairy products.  However, when someone also needs to avoid eating eggs, nuts and seeds, along with the nightshade vegetables, this makes it even more challenging.  And of course it’s even more challenging for a strict vegetarian or vegan to follow an autoimmune paleo diet, as they won’t be consuming any meat or fish.

Why Is An Autoimmune Paleo Diet So Restrictive?

Why are so many foods excluded from an autoimmune paleo diet?   Well, there are a few different reasons.  An autoimmune paleo diet excludes foods people with autoimmune conditions are commonly sensitive to such as gluten, dairy, eggs, and corn.  These foods can cause inflammation and/or exacerbate an existing inflammatory condition.  Gluten can directly cause an increase in intestinal permeability (a leaky gut), which is a factor in many, if not all autoimmune conditions.  Other foods such as all grains, legumes, and the nightshade vegetables are restricted because they contain antinutrients which not only affect the absorption of nutrients, but like gluten, can also have a negative effect on the gut.  So it’s not just gluten which potentially can cause a leaky gut, but other foods can potentially cause this as well.  Essentially those foods which are excluded from an autoimmune paleo diet are those foods which can cause gut inflammation and/or an increase in intestinal permeability.

I must admit that I do like the autoimmune paleo diet, and I commonly recommend this to my patients with Graves’ Disease and Hashimoto’s Thyroiditis.  However, there are a few “flaws” with this type of diet:

1) Some people do fine eating one or more of the restricted foods. A good example of this is eggs.  There are many people who are able to eat eggs without a problem, especially egg yolks.  And eggs are an excellent source of nutrients.  With regards to dairy, although I recommend for people to avoid dairy while trying to restore their health, some people with autoimmune thyroid conditions do okay when consuming dairy products.  This is especially true with raw dairy products.  I’ve also had some people with Graves’ Disease and Hashimoto’s Thyroiditis eat small amounts of gluten free grains and still receive good results.  I’ve also had a few patients eat soaked nuts while following the protocol and do well.  The problem is that it’s difficult to predict who will do fine eating some of the restricted foods, which is why many healthcare professionals recommend for all of their patients with autoimmune thyroid conditions to avoid all of these foods.

2) It is possible to be sensitive to the “allowed” foods. Someone can be strictly following an autoimmune paleo diet and then find out that they are sensitive to another food they are eating which is permitted.  For example, they might have a sensitivity to chicken or beef, or even a vegetable or fruit they are eating on a frequent basis.  And while sometimes a person will experience negative symptoms upon eating these foods, other times there won’t be any overt symptoms.  This admittedly can be frustrating, as a person might be following a strict autoimmune paleo diet and might be feeling better from a symptomatic perspective.  But upon doing some retesting they notice their numbers aren’t improving.  For example, someone’s thyroid panel might worsen even though they are feeling better, and  while this doesn’t mean this is due to a food allergen, it is possible.  Perhaps a better example is someone who initially tests positive for an increase in intestinal permeability, and upon getting this retested a few months later the results show that their leaky gut has gotten worse.  Once again, this might not necessarily be attributed to a food sensitivity, although it very well might be.

3) Some people find the diet to be too restrictive. I find this to especially be true with those patients who have Graves’ Disease, although sometimes this will also be the case with those who have Hashimoto’s Thyroiditis.  The problem with Graves’ Disease is that the increased metabolism usually leads to weight loss, which can be extreme in some cases.  While some people with an autoimmune hyperthyroid condition will lose a small amount of weight (i.e. 5 to 10 pounds), others will lose 20 pounds or greater.  As an example, when I was dealing with Graves’ Disease I lost over 40 pounds.  Many people find it difficult to gain weight when dealing with Graves’ Disease, and sometimes this is true with Hashimoto’s Thyroiditis patients as well.

Of course everyone is different, and many of my patients with Graves’ Disease do fine when following an autoimmune paleo diet.  On the other hand, others struggle with the restrictive diet.  Although I try to encourage my patients to stick with the diet, if someone is about to break the diet due to the fear of losing even more weight, I’d much rather them eat some “forbidden” yet healthy foods (i.e. eggs, nuts, seeds, tomatoes, etc.) than completely ruin their diet by eating junk food.  And so there are times when I’m fine with people reintroducing one or more of the excluded foods and see how they do.  When taking this approach I will always have them reintroduce one food at a time for three consecutive days.  For example, if someone wants to reintroduce nuts, I’d have them start with almonds, and preferably soak them overnight to help reduce the antinutrients.  Then I would have them eat some almonds for three consecutive days and to pay close attention to any symptoms they might experience.

Who Should Follow An Autoimmune Paleo Diet?

I currently recommend an autoimmune paleo diet to just about all of my patients with Graves’ Disease and Hashimoto’s Thyroiditis.  However, as I just mentioned, I will make modifications if necessary.  Plus, one needs to consider that autoimmune thyroid conditions are a little bit different than many other autoimmune conditions.  For example, there is the concern of goitrogenic foods, which in my opinion isn’t a huge concern in people with hypothyroid conditions.  But it’s still something to be aware of, and I have discussed this in other articles.  Eating foods rich in iodine such as seafood and sea vegetables is commonly recommended with other autoimmune conditions.  And while many people with autoimmune thyroid conditions do fine eating these foods, some people get worse when eating foods rich in iodine.  I’ll soon be releasing an article which talks about the impact of seafood and sea vegetables on thyroid health.

With regards to the restrictive diet, I’m open to patients reintroducing egg yolks after one month if they’re struggling on the diet.  And while I prefer for patients to avoid grains, if adding a few servings of gluten free grains each week will make someone more compliant with the other recommendations then I’m usually fine with them trying this.  The same thing applies with properly prepared nuts.  This doesn’t mean that everyone will do fine eating these foods, but if they are going to stray from the diet I’d rather them eat a small bowl of rice than a bowl of whole wheat pasta or a slice of pizza. Obviously there are certain foods I won’t allow under any circumstances, although just because I recommend avoiding a specific food doesn’t always mean the patient will follow my recommendations while trying to restore their health.  It’s not uncommon for me to receive an email from a patient who ate something they weren’t supposed to, and sometimes it can be challenging for them to  get back on track with the diet.  Just remember that while you want to continue eating well even after you have restored your health back to normal, you won’t necessarily have to follow a strict autoimmune paleo diet on a permanent basis.

In summary, an autoimmune paleo diet is recommended by many natural healthcare professionals to those people with Graves’ Disease and Hashimoto’s Thyroiditis, as well as those with other types of autoimmune conditions.  Although I commonly recommend this type of diet to my patients with autoimmune thyroid conditions, some people do fine eating some of the restricted foods, and it’s possible to be sensitive to foods which are permitted.  In addition, some people find this diet to be too restrictive and therefore have a difficult time sticking to it.  As a result, there are times when I will make modifications to this diet if necessary, although I do encourage people to try to stick as close to the diet as possible for optimal results.

In the last post I discussed some of the basics of autoimmunity, including why some people develop specific autoimmune conditions such as Graves’ Disease and Hashimoto’s.  I also discussed the role of human leukocyte antigen (HLA) in autoimmunity, as well as the importance of regulatory T cells in preventing autoimmunity.  In this post I will discuss the autoimmunity timeline, which will help you to better understand the different stages of thyroid autoimmunity.

If you read the last post then you probably understand that in order for autoimmunity to develop, a combination of genetic and environmental factors are necessary.  However, having a genetic surface marker and being exposed to an environmental trigger usually isn’t enough to lead to an autoimmune condition.  If this were true, then many more people would develop autoimmunity, as many people with these genetic markers are exposed to one or more environmental triggers, yet don’t develop an autoimmune condition.  And so other factors are necessary, such as a decrease in regulatory T cells, and perhaps an increase in intestinal permeability (a leaky gut).  Healthy mitochondria are also important, as several mitochondrial proteins have been implicated as regulators of apoptosis in the immune system that are required for prevention of autoimmunity (1).  I’m sure there are other factors as well which we’re unaware of at this time.

Understanding The Autoimmunity Timeline

But in addition to understanding what factors can lead to the development of an autoimmune thyroid condition such as Graves’ Disease or Hashimoto’s Thyroiditis, it is also beneficial to understand the autoimmunity timeline.  After all, most chronic health conditions take many years to develop.  And then when they do develop, it can take many more years for symptoms to manifest.  So let’s go ahead and look at different stages of autoimmunity:

Stage #1: Pre-autoimmunity. This is the most critical time to prevent an autoimmune condition from developing.  As I mentioned numerous times in the last post, having a genetic marker and being exposed to an environmental trigger usually won’t cause an autoimmune condition without other factors being present.  I mentioned a decrease in regulatory T cells as being a factor.  A leaky gut can also be a factor in some, if not all autoimmune conditions.  Mitochondrial dysfunction can also be a factor.  But it usually takes years for people to develop a significant decrease in regulatory T cells, a leaky gut, or mitochondrial dysfunction.

So the goal in most people should be to do whatever is necessary to have a healthy immune system, a healthy gut, and healthy mitochondria.  Obviously there is a lot of overlap, as someone can’t have a healthy immune system without having a healthy gut.  And one also needs healthy mitochondria to have a healthy immune system.  Of course there are many factors which can have a negative effect on the these areas, such eating a poor diet with a lot of refined foods and sugars, consuming common allergens such as gluten and dairy, being exposed to prolonged chronic stress, getting insufficient sleep for many months or years, toxic overload, an acute or chronic infection, etc.

As you can see, there are a lot of different factors which can  set the stage for autoimmunity.  Keep in mind that in most cases, if someone has a genetic marker for an autoimmune condition, a SINGLE exposure to an environmental trigger isn’t going to cause autoimmunity.  After all, most people deal with chronic stress these days, everyone is exposed to toxins, etc.  However, if someone is FREQUENTLY exposed to one of more of these factors, then over time this can cause a decrease in regulatory  T cells, lead to a leaky gut, and/or cause mitochondrial dysfunction, and set the stage for autoimmunity.  So perhaps the best way to think of it is that we’re all exposed to one or more of these triggers, but it’s the frequent exposure to these triggers over time which increases the likelihood of someone developing an autoimmune condition.

Stage #2: Silent autoimmunity. In this stage, autoimmunity has already been triggered.  However, there has been very little or no tissue damage, and therefore no symptoms are present, and the blood test results are negative at this point (i.e. normal TSH and thyroid hormone levels).  This is what happens with pretty much all autoimmune conditions.  However, the duration of this stage will vary greatly depending on the autoimmune condition.  For example, if someone has elevated thyroglobulin antibodies, which are associated with Hashimoto’s Thyroiditis, then there is a good chance that these will cause damage to the thyroid gland.  And if nothing is done to address the autoimmune component then the damage can be so extensive that the person might reach the point where they need to take thyroid hormone medication.

However, the person with Hashimoto’s Thyroiditis can be in the “silent” phase for many years.  With Graves’ Disease it may be a different story, as my guess is that the silent phase isn’t nearly as long.  And the reason for this is because when dealing with autoimmune conditions which involve tissue damage (i.e. Hashimoto’s, multiple sclerosis), the tissue damage can be minimal for many years, and so in some cases it can take a long time for the person to develop symptoms, which I’ll discuss next in phase #3.  Graves’ Disease is different from many other autoimmune conditions in that it doesn’t necessarily involve tissue damage.  The TSH receptor antibodies don’t seem to damage the TSH receptors, but apparently stimulate them, which results in the release of thyroid hormone.  And the symptoms of Graves’ Disease are usually more noticeable initially than those of many other autoimmune conditions.  Although in some cases it might take many years between the time someone develops Graves’ Disease autoantibodies and the time they develop hyperthyroid symptoms, in my opinion this is less likely to happen.

Stage #3.  Symptoms present with some tissue loss. Although stage #2 might involve some tissue damage, it’s very minimal, and it’s in stage #3 where this damage reaches the point where the person begins to experience symptoms.  Once again, it can take many years for this to happen.  So with the person who has Hashimoto’s Thyroiditis, what frequently will happen is that due to the tissue damage to the thyroid gland, the person will begin to experience some symptoms.  As a result, they might visit their medical doctor, who will run a thyroid panel, and at this point the TSH might be elevated, or it still might look fine.  Obviously one can’t rely on the TSH alone, but unfortunately this still is what frequently happens at many medical doctor’s offices.  And if the TSH is within the lab reference range, regardless of how the person feels, they might be told that everything is fine since the tests are within the normal reference range.  On the other hand, a smart doctor will run a more comprehensive panel which not only evaluates the thyroid hormone levels (which probably will also be normal), but they will also look at the thyroid antibodies, in this case thyroperoxidase antibodies and thyroglobulin antibodies.

Unlike Hashimoto’s Thyroiditis, when someone with Graves’ Disease is experiencing symptoms there usually is a correlation with the blood test results.  So for example, if someone has elevated TSH receptor antibodies and begins experiencing hyperthyroid symptoms (i.e. increased pulse rate, heart palpitations, tremors, etc.) then there is a good chance the TSH will be depressed and/or the thyroid hormone levels will be elevated, although this isn’t always the case.  As I’ve mentioned in other articles and posts, for some people with Hashimoto’s Thyroiditis and Graves’ Disease, the thyroid antibodies will show up as being negative when doing a blood test.

Stage #4.  Symptoms are present and there is greater tissue loss. This is the “final” stage of autoimmunity, as it’s when the person’s symptoms will usually worsen, there will be greater tissue loss, and the blood tests will be positive.  Although some people might be diagnosed with an autoimmune thyroid condition in stage #3, especially those with Graves’ Disease, many people with Hashimoto’s Thyroiditis won’t be diagnosed until they reach stage #4.  And the reason is because most of the symptoms of Hashimoto’s Thyroiditis can’t be measured.  In other words, if someone with Hashimoto’s Thyroiditis is in stage #3 and presents with negative blood tests, yet they are experiencing symptoms such as fatigue, brain fog, and hair loss, these symptoms can’t be measured.  On the other hand, if someone with Graves’ Disease is in stage #3 they very well might have an elevated heart rate, which will be detected almost immediately when the vital signs are being taken.  Getting back to Hashimoto’s Thyroiditis, if someone is in stage #3 and has negative blood tests, often times doing a good case history and conducting a thorough physical exam can determine if  someone has a thyroid condition.  But this isn’t always the case, and unfortunately, many medical doctors see such a high volume of patients that they won’t perform a thorough physical exam if all of the tests look good.

In summary, different autoimmune conditions are characterized by different types of autoantibodies.  There are a few factors which will determine whether autoimmunity will develop, as a genetic marker is usually present, and an environmental trigger is also necessary.  However, other factors are usually necessary to set the stage for autoimmunity, such as a decrease in regulatory T cells, a leaky gut, and/or mitochondrial dysfunction.  So in order to prevent autoimmunity, or restore the health of someone who already has an autoimmune condition it would appear to be necessary to have high numbers of regulatory T cells, a healthy gut, and healthy mitochondria.  I also discussed the four stages of autoimmunity, which should also help you to understand the progression of most autoimmune conditions.

Autoimmune conditions are the third most common chronic health condition following heart disease.  There are over 80 different types of diagnosed autoimmune conditions, and dozens of other conditions are suspected as being an autoimmune condition.  But what causes autoimmunity, and why does someone develop a specific autoimmune condition and not another?  For example, why do some people develop Graves’ Disease but not Hashimoto’s Thyroiditis, and vice versa?  And why do some people have the antibodies for both of these autoimmune thyroid conditions?

Autoimmunity happens when the body doesn’t recognize its own cells and tissues as self, and this in turn leads to an immune response against these cells and tissues.  Hashimoto’s Thyroiditis is a condition characterized by autoantibodies against the cells and tissues of the thyroid gland.  Over time these autoantibodies frequently cause sufficient damage to the thyroid gland, which prevents it from producing adequate amounts of thyroid hormone.  On the other hand, Graves’ Disease involves autoantibodies against the TSH receptor antibodies, which in turn causes the thyroid gland to secrete an excessive amount of thyroid hormone.

On a short term basis it is usually far worse to have Graves’ Disease, as while the antibodies aren’t causing damage to the thyroid gland, the excessive production of thyroid hormone can result in extreme cardiac symptoms, and in some cases can even be life threatening.  In addition, some people have thyroid eye disease, where the TSH receptor antibodies will attack the tissues of the eyes.  Unlike some cases of Graves’ Disease, most cases of Hashimoto’s Thyroiditis aren’t considered to be emergency situations.  With that being said, many people with Hashimoto’s Thyroiditis have severe and sometimes debilitating symptoms.  And over the long term, if the autoimmune response isn’t addressed then there is a good chance the person with Hashimoto’s Thyroiditis will become hypothyroid, and thyroid hormone medication might be necessary to take.

Why Do People Develop Graves’ Disease and Hashimoto’s Thyroiditis?

As I mentioned earlier, there are many different autoimmune conditions.  But why does autoimmunity develop, and what factors determine whether someone will develop an autoimmune thyroid condition, or another autoimmune condition such as rheumatoid arthritis or multiple sclerosis?  Well, there are a combination of different factors which determine whether someone will develop an autoimmune condition.  First of all, in most cases a genetic marker is required.  I’m going to talk more specifically about this shortly.  Second, there needs to be some type of an environmental trigger, such as a food allergen, toxin, or infection.  Even stress can potentially be a trigger of autoimmunity.

In addition, some researchers speculate that a third factor is required to develop an autoimmune condition, which is hyperpermeability of the small intestines, also known as a leaky gut.  As of now this still remains controversial, and I have written about this controversy in past blog posts, specifically in a post entitled “Is A Leaky Gut Present In All Autoimmune Conditions?“.  In this post I discussed how many of my patients with Graves’ Disease and Hashimoto’s Thyroiditis have a leaky gut, but I also have had some patients with elevated autoantibodies test negative for a leaky gut using either the classic lactulose/mannitol test, or the Array #2 from Cyrex Labs.  Perhaps neither of these tests are 100% accurate in confirming the presence of a leaky gut, but it’s also possible that not everyone with an autoimmune condition has an increase in intestinal permeability.

The Role of Human Leukocyte Antigen (HLA) In Autoimmunity

I prefer to keep my articles and blog posts easy to understand, but the next few paragraphs might be a little bit advanced for some people.  Different autoimmune conditions will have different types of genetic markers, and something called human leukocyte antigen (HLA) is a type of genetic surface marker.  Keep in mind that there still is a lot to learn in the world of autoimmunity, as some of the autoimmune mechanisms discussed in journal articles are hypothetical, including what I mentioned earlier about intestinal permeability possibly being a factor in all autoimmune conditions.  But it is a fact that there are different genetic surface markers, and someone who has Graves’ Disease will have different genetic surface markers than those people who have Hashimoto’s Thyroiditis.  And there are some people who have the genetic surface markers for both Graves’ Disease and Hashimoto’s, which is why some people will have both types of autoantibodies.

What makes this complex is that an autoimmune condition can have more than one genetic surface marker which predisposes the person to developing multiple autoimmune conditions, and some autoimmune conditions share the same surface markers.  With regards to HLA, it’s also beneficial to understand that these genetic surface markers aren’t just a factor in autoimmune conditions, but in other chronic health conditions as well, such as cancer.  With regards to autoimmunity, people with certain HLA types are more likely to develop an autoimmune condition.  However, just having a specific HLA genetic surface marker doesn’t mean that the person will develop autoimmunity.

For example, many people are familiar with the HLA markers associated with Celiac disease, which are HLA-DQ2 and HLA-DQ8.  If someone has one or both of these markers it doesn’t necessarily mean that they will develop Celiac disease.  This is true even if they consume gluten, which is the environmental trigger associated with Celiac disease.  So what this tells us is that having a genetic marker and being exposed to an environmental trigger doesn’t always lead to autoimmunity.

Let’s look at another example.  Someone with Graves’ Disease might have the genetic surface marker HLA-DR3.  Unlike Celiac disease, there is no specific trigger that is associated with all cases of Graves’ Disease, as it appears that numerous factors can trigger the autoimmune response in this condition.  And the same is true with Hashimoto’s Thyroiditis and many other autoimmune conditions.  In any case, someone with the genetic surface marker HLA-DR3 who is exposed to a certain environmental trigger (i.e. chronic stress, H. Pylori), might develop Graves’ Disease, whereas another person with the same surface marker who is exposed to the same trigger might not develop Graves’ Disease.  What makes it even more challenging is that other autoimmune conditions can also have the genetic surface marker HLA-DR3, such as Sjogren’s syndrome and systemic lupus erythematosus.

The Importance of Regulatory T Cells In Preventing Autoimmunity

While this might be confusing to some people reading this, what hopefully is clear at this point is there are factors other than genetics and environmental triggers which will determine whether someone will develop an autoimmune thyroid condition, or any other autoimmune condition for that matter.  One of these factors is something called regulatory T cells, as these are immune cells which help to prevent autoimmunity from occurring.  I’m not going to discuss this in detail, as in the past I wrote a separate blog post on this topic entitled “Regulatory T Cells and Thyroid Autoimmunity“.  But essentially, if someone has a healthy immune system, they will have plenty of regulatory T cells, and this will help to prevent them from developing an autoimmune condition.  On the other hand, over a period of years, if someone eats a poor diet, is constantly stressed out, and/or doesn’t get quality sleep each night, then this will lead to a decrease in regulatory T cells, and will increase the likelihood of the person developing autoimmunity.

So a very likely scenario is that someone has the genetic surface marker for Graves’ Disease, Hashimoto’s Thyroiditis, or another autoimmune condition, and despite being exposed to numerous environmental triggers they don’t develop autoimmunity unless their body reaches a point where there isn’t enough regulatory T cells present to keep autoimmunity in check.  However, certain factors can potentially affect the number of regulatory T cells, such as a chronic infection, a leaky gut, mitochondrial dysfunction, and nutrient deficiencies such as low vitamin D levels.  Autoimmunity is very complex, and as I mentioned earlier, there is still a lot we don’t know about autoimmune conditions.

In the next blog post I’ll discuss the autoimmunity timeline, and will go over the different stages of autoimmunity.  Most people reading this know that it takes time for thyroid autoimmunity to develop, and these four stages should allow you to better understand why many people with these conditions don’t receive proper care until the later stages.  Plus, since there is a genetic component involved with most, if not all cases of Graves’ Disease and Hashimoto’s Thyroiditis, if you have either of these conditions then you probably will want to share this information with your siblings and children, as it can help to prevent someone from developing a full blown autoimmune condition.

Most of the diets for people with thyroid and autoimmune thyroid conditions are quite restrictive.  This is especially true with regards to autoimmune thyroid conditions, as most autoimmune diets will advise patients to not only avoid gluten, dairy, and grains, but will usually advise the patient to avoid eggs, nuts, seeds, legumes, as well as the nightshade vegetables.  And to top it all off, those with hypothyroidism and Hashimoto’s Thyroiditis are frequently told to avoid goitrogenic foods such as broccoli, kale, spinach, etc.  And unlike other autoimmune conditions, many with autoimmune thyroid conditions are also told to avoid seafood and sea vegetables due to the high iodine content.  So you might wonder what foods you CAN eat without having a negative effect on your health.

I’d like to begin by saying that there is no single diet that perfectly fits everyone.  For example, I commonly recommend an autoimmune Paleo diet to my patients with Graves’ Disease and Hashimoto’s Thyroiditis.  As I mentioned in the opening paragraph, one of the foods you’re supposed to avoid while following this diet is eggs.  And one reason for this is because a lot of people have a sensitivity to eggs.  Another reason is because egg whites have proteins  which can have a negative effect on gastrointestinal health.  Although I do have most of my patients avoid eggs initially, eggs are very nutrient dense, and not everyone with an autoimmune thyroid condition needs to avoid eggs for a prolonged period of time.  This is especially true with regards to egg yolks.  So while some people will need to avoid eggs, other people are able to incorporate them into their diet.  Others might be fine eating egg yolks but not egg whites.

On the other hand, fermented vegetables such as sauerkraut are allowed on most autoimmune diets, and are a big part of certain diets such as the GAPS diet.  However, if someone has a condition such as small intestinal bacterial overgrowth (SIBO), then they might not be able to eat fermented foods, along with some other foods.  So hopefully you understand that there are some foods that typically aren’t allowed on an autoimmune diet which some people can tolerate, as well as other foods which are allowed but might not be tolerated by some people.

What’s The Rationale Behind Excluding Certain Foods?

Before I list the foods which most people with thyroid and autoimmune thyroid conditions can eat, I figured it would be a good idea to briefly explain why certain foods are normally excluded.

Common Allergens. This includes gluten, dairy, corn, soy, and eggs.  The reason why these foods are excluded is because many people have food sensitivities/intolerances to them.  Of course with gluten it can be more serious than a food sensitivity or intolerance, as people with Graves’ Disease and Hashimoto’s Thyroiditis have an increased incidence of Celiac disease, which I discussed in my article “Celiac Disease and Thyroid Health“.  But even if someone doesn’t have Celiac disease, they still can be sensitive to gluten, as well as to these other foods.  And if someone eats foods they are sensitive to, this will cause inflammation, and in some cases can also cause an increase in intestinal permeability (a leaky gut).

You might wonder why you can’t simply test for food allergies and intolerances.  After all, people can have allergies and intolerances to foods other than the ones I mentioned in this post.  This without question is true, and although there are numerous labs which perform food intolerance testing, the accuracy of these tests remain controversial.  I usually just recommend an elimination diet, followed by the reintroduction of certain foods.  Although I realize that there are limitations to doing this, in my opinion it’s more accurate than food intolerance testing, and a lot less expensive.  Of course it’s also very time consuming to do this, and so it would be great if there was a lab which was accurate in testing for food intolerances.

Grains. Why should grains be avoided?  After all, certain grains such as rice, millet, and buckwheat don’t have gluten.  First of all, keep in mind that I’m not “anti-grain”.  Although we can live fine without eating any grains, many people can tolerate a small amount of gluten free grains.  But one problem is that many people don’t eat a small amount of these foods, which are high in carbohydrates.  And in most cases you want to minimize your carbohydrate intake.  Keep in mind that I’m not telling you to eat a low carbohydrate diet, but instead to avoid eating a high carbohydrate diet.  But a bigger problem than the high amount of carbohydrates is that these foods are also high in certain anti-nutrients, such as phytates.  These anti-nutrients not only affect the absorption of nutrients, but can also have a negative effect on the health of the gut.

Nuts, seeds, and legumes. Although these foods have some good health benefits, they also have anti-nutrients which can have a negative effect on the gut.  And since many people with autoimmune thyroid conditions have a leaky gut, it is best to avoid these foods while trying to repair the gut.  In fact, some researchers claim that everyone with an autoimmune condition has a leaky gut, although I’m not sure if this is the case, and I actually discussed this in a post entitled “Is A Leaky Gut Present In All Autoimmune Thyroid Conditions?“.

Nightshades. The nightshade vegetables include tomatoes, eggplant, white potatoes, and peppers.  Although these foods do have some healthy nutrients, they also have compounds which can cause inflammation in lot of people, and can potentially cause an increase in intestinal permeability.  Soon I’ll be releasing a separate article which goes into greater detail about these foods.

High glycemic index fruit. Although fruit is very healthy, it still is a source of sugar, and thus you want to be careful not to eat a large quantity of high glycemic index fruit on a frequent basis.  The higher the glycemic index, the faster it raises your blood sugar levels, and this includes fruits such as watermelon and cantaloupe.  This doesn’t mean that eating these foods once in awhile will cause problems, but in order to keep the blood sugar levels stable you want to eat fruit with a lower glycemic index such as blueberries, blackberries, raspberries, strawberries, and apples.  This is especially true in those who currently have blood sugar imbalances.

All refined foods and sugars, fast food, and artificial ingredients. I probably didn’t have to include this, but I figured I’d do so just to be on the safe side.  Just about everyone reading this knows they should avoid all of these foods, and stick with the whole, healthy foods.

Foods That MOST People With Thyroid and Autoimmune Conditions CAN Eat

Vegetables. Most people reading this know that vegetables are among the healthiest foods.  Even though this is true, the fact remains that most people don’t eat enough vegetables.  This applies to many people who eat healthy diets, as while every now and then I’ll consult with someone who before working with me was eating five or more servings of vegetables per day on a consistent basis, many people struggle to include a couple of servings of vegetables in their daily eating regime.  Not only do you want to eat plenty of vegetables, but you also want to try eating a wide variety of them.  I recommend a combination of raw and cooked vegetables.

Are there any vegetables that you shouldn’t eat?  Well, I mentioned the nightshade family of vegetables earlier.  I’m sure many people who have hypothyroidism and Hashimoto’s Thyroiditis are wondering about goitrogenic foods such as broccoli, kale, and cauliflower.  If someone with a hypothyroid condition has greatly depressed thyroid hormone levels and/or a severe iodine deficiency then it might be best to avoid these foods.  However, most people can eat small amounts of these foods on a daily basis.  And remember that cooking vegetables will help to reduce the goitrogenic activity.  I discussed goitrogens in my article entitled “An Update on Goitrogenic Foods and Their Impact on Thyroid Health“.

Fermented vegetables. Most people should eat plenty of fermented vegetables, such as sauerkraut and kimchi.  These foods are a great source of probiotics.  However, some people are unable to eat fermented foods, such as those who have problems with FODMAPs.  I spoke about this more in a blog post I wrote entitled “Should People With Thyroid Conditions Follow a Low FODMAP Diet?“.  When someone has problems eating fermented foods it usually is due to intestinal dysbiosis.  An example is the condition known as small intestinal bacterial overgrowth, also known as SIBO.

Low glycemic index fruit. Although those who don’t have blood sugar imbalances can eat some high glycemic index fruits every now and then, it still is best to stick with those foods that have a low glycemic index.  I mentioned some of these foods earlier, as this includes all types of berries, as well as apples, pears, and cherries.  Avocados are very nutrient dense and are an excellent source of healthy fats.

Meat and Poultry. This obviously doesn’t apply to vegetarians and vegans, but for those who eat meat, eating healthy forms of meat and poultry is fine.  For example, if you eat beef then you ideally want to eat organic, grass-fed beef.  If you eat poultry then you ideally want this to be organic as well.  Other types of meat such as lamb, deer, and porcupine are fine to eat, providing you remove  the quills before cooking it.  Okay, I’m just joking about eating porcupine, although I’m sure it’s a delicacy in some countries.  Organ meats are nutrient dense and also can be eaten.

Fish. Fish is the best source of omega 3 fatty acids, has other nutrients, and is a good source of protein.  Of course fish also has toxins, and while the larger fish and the farm-raised fish have the greatest number of toxins, there are still toxins present in smaller, wild fish.  With that being said, in most cases it is fine for people to have two or three servings of wild fish per week.  Some healthcare professionals feel that it’s fine to eat fish on a daily basis as long as the selenium content is greater than the amount of methylmercury, although I’m still cautious about people eating more than three servings of fish per week.

Coconut. Most people with thyroid and autoimmune thyroid conditions can also eat coconut products without a problem.  Of course there are some people who can’t tolerate coconut, including some people with SIBO.  But most people can have some coconut milk, coconut yogurt, and I highly recommend coconut oil for those who can tolerate it.  With that being said, you do need to be careful about some of the processed coconut products sold at health food stores, as some people will react to the other ingredients included.  This doesn’t mean that you can’t eat any of these products, but you want to read the labels carefully, and you might also want to consider making your own coconut milk and yogurt.

Other Foods. Many herbs and spices are allowed such as basil, cilantro, garlic, ginger, oregano, parsley, rosemary, and thyme.  Apple cider vinegar is allowed, as is olive oil.  Drinking green tea and many herbal teas are fine.

Additional Foods That SOME People With Thyroid and Autoimmune Conditions Can Eat

Eggs. Although eggs are a common allergen and therefore can’t be consumed by some people, not everyone with an autoimmune thyroid condition will need to avoid eggs.  And since eggs have many different nutrients and are a good source of protein, if someone doesn’t react to eggs I think they should eat them.  As I mentioned earlier, many people do fine eating egg yolks but should consider avoiding egg whites.

Soaked nuts and seeds. As I mentioned earlier, the main reason nuts and seeds should be avoided is because they can have a negative effect on the gut, and many people with autoimmune thyroid conditions have a leaky gut.  Lectins are a big culprit, and soaking nuts and seeds will help to reduce the lectin content.  I’ve had some people with a leaky gut eat soaked nuts and seeds and not have it affect their recovery.  On the other hand, I’ve also had some people with a leaky gut follow a strict autoimmune Paleo diet while eating soaked nuts and seeds, and on an intestinal permeability retest they showed little or no improvement.  Although there could have been other factors responsible for this, it very well might have been the nuts and seeds.  One of the benefits of nuts and seeds is that they make a great snack, as they are a good source of protein and fiber, and don’t raise the blood sugar levels.  But in some cases they can also prevent a leaky gut from fully healing.

Raw dairy. I realize that raw dairy isn’t available in all states, and for some people who wonder why I would specifically list raw dairy and not pasteurized dairy, I would read my blog post entitled “Should People With Graves’ Disease and Hashimoto’s Thyroiditis Avoid Dairy?“.  I also should let you know that I frequently don’t have people reintroduce any type of dairy while following a natural treatment protocol.  But I realize this diet is very restrictive, and while many people don’t do well with any type of dairy, some people can tolerate raw dairy.  And some people also seem to do fine with dairy from a goat or sheep.  Although I don’t encourage people to add dairy into their diet, if someone is struggling to follow this diet and they request to reintroduce dairy, I will usually allow them to do so and see how they respond.  However, it’s important to only reintroduce one dairy product at a time for three consecutive days, as it’s possible to react to one type of dairy, but not to react to a different type.

Other foods. Can people safely consume other types of foods?  For example, I’ll commonly get asked if someone can eat a small amount of gluten free grains, such as gluten free oats, rice, or a “pseudo grain” such as quinoa.  Earlier I gave the reason why grains are usually excluded.  And while eating rice, or gluten-free bread or pasta is better than eating whole wheat bread or whole wheat pasta, even gluten-free grains have antinutrients, spike up the blood sugar levels, etc.  With that being said, there are some people who are able to eat small amounts of gluten-free grains without a problem.  But if someone has a leaky gut and/or blood sugar imbalances then I would strongly consider going grain free.

I’ll also have some people wonder if they can reintroduce some of the nightshades.  Although some people can eat nightshades without a problem, other people can’t eat them without experiencing symptoms such as joint pain, headaches, and other symptoms caused by these foods.  Nightshades can also potentially cause a leaky gut, and so if someone has gut issues but isn’t experiencing any negative symptoms while consuming nightshades, then it still would be a good idea to avoid these foods.

“How Do I Know If I Can Eat These Additional Foods?”

At this point you might be wondering how would you know if you can eat eggs, soaked nuts and seeds, raw dairy, etc.  I usually will have my patients follow an elimination diet.  I’ll typically have them follow an autoimmune Paleo diet, and then after one month if they are struggling and feel the need to reintroduce certain foods I will usually have them start with eggs.  I would have them reintroduce eggs into their diet by having them eating one or two eggs daily for three or four consecutive days and to pay close attention to any symptoms they might experience.  Once again, it might be wise to only reintroduce egg yolks.  If they experience any symptoms (i.e. headaches, increase in fatigue, etc.), but are unsure whether or not it is related to the food they reintroduced, or if it’s just a coincidence, I will have them cut out the food again for a few weeks and then they can try reintroducing it back again.  Although this method isn’t perfect, if someone pays close attention to the changes in symptoms they usually can tell if they are having a negative reaction to a specific food.  As I just mentioned, eggs is one of these foods, and although I don’t frequently recommend for people to add raw dairy into their diet, if someone does this and has a sensitivity to the proteins in dairy then they will usually be able to tell if they are reacting upon reintroducing the dairy.

On the other hand, it can be a different story with soaked nuts and seeds.  With eggs and dairy, these foods are not part of an autoimmune Paleo diet because many people have allergies or intolerances to them (although as I mentioned earlier, egg whites can have a negative effect on the gut).  With nuts and seeds, as well as beans/legumes, while someone also can have an allergy or intolerance to these foods, the primary reason why they are excluded from this type of diet is due to the negative effects they can have on gastrointestinal health.  Eliminating these for one month and then reintroducing them might not result in any symptoms unless if you have a true allergy, or a problem breaking down fats due to another problem (i.e. bile/gallbladder problem).  So while some people with thyroid and autoimmune thyroid conditions eat soaked nuts and seeds and do fine, other people don’t do well until they eliminate the nuts and seeds from their diet.

Focus On Nutrient Density

Even though one might find the diet to be restrictive, just remember that the goal isn’t to limit your caloric intake.  I realize that it might seem challenging to eat enough calories with such a limited diet, but just keep in mind that there is a difference between foods that are high in calories and foods that are nutrient dense.  For example, a bowl of rice will be higher in calories than a bowl of kale, but the bowl of kale will have a much higher nutrient density.  To be fair, nuts and seeds are nutrient dense foods yet are excluded from an autoimmune Paleo diet, but most of the other foods listed are nutrient dense.

Also keep in mind that there is no single diet that will fit everyone.  Earlier I gave the rationale behind excluding certain foods, but not everyone will need to avoid eating these foods while trying to restore their health back to normal.  And what makes it even more frustrating is that with certain foods there is no surefire method to confirm that it is safe to eat this food, or if it should be avoided.  Some doctors like myself use an elimination diet, others might use food sensitivity/intolerance testing, while some doctors use applied kinesiology, which involves muscle testing to see if a certain food is allowed or should be avoided.  All of these methods have limitations, which is why many healthcare professionals recommend for everyone with an autoimmune condition to avoid all of the potentially problematic foods.

In summary, although most people who follow a natural treatment protocol will be put on a restrictive diet, it’s important to understand that there is no single diet which will be a perfect fit for everyone.  While myself and many other doctors will recommend for those who have Graves’ Disease and Hashimoto’s Thyroiditis to be put on an autoimmune Paleo diet, not everyone needs to avoid all of these foods.  On the other hand, at times some people might not be able to tolerate some of the “allowed” foods.  So while many people will benefit by avoiding the common allergens (gluten, dairy, corn, soy, and eggs), going grain-free, avoiding nuts, seeds, and legumes, along with the nightshades, and fruit which have a high glycemic index, not everyone who is trying to restore their health will need to avoid all of these foods.  Also remember that you don’t want to worry too much about consuming foods high in calories, but instead want to eat foods with a high nutrient density.

Many women with thyroid and autoimmune thyroid conditions have fertility problems.  And it’s also common for men to experience fertility problems as well.  It’s been awhile since I’ve written about this, and so I figured I’d put together a post discussing some of the most common reasons why many men and women have problems conceiving.  Although there isn’t always a natural solution to infertility, many women who at one time had problems getting pregnant and who didn’t want to consider fertility treatments such as IVF were able to conceive following some of the advice given below.  In addition, while the focus is on people with thyroid and autoimmune conditions, many people suffering from infertility who don’t have a thyroid condition can also benefit from this information.

Infertility is defined as the inability to conceive after one year of regular intercourse without contraception. The prevalence of infertility is estimated between 12% and 14% and has remained stable in recent years (1).  There are many different causes of infertility, but not surprisingly, many doctors overlook these causes, and as a result many couples resort to fertility drugs or IVF, which can cost thousands of dollars, and many times these methods aren’t successful.  As a result of this I have listed numerous factors which can potentially cause or contribute to infertility.

1. Thyroid hormone imbalance. There is no question that having a thyroid condition can cause infertility, as many studies have shown that thyroid dysfunction can affect the male and female gonads, interferes with human reproductive physiology, reduces the likelihood of pregnancy and adversely affects pregnancy outcome (2) (3) (4).  It also seems that both hypothyroid and hyperthyroid conditions can be factors.  As a result, anyone with depressed or elevated thyroid hormone levels will ideally want to get this problem addressed before trying to conceive.

2. The presence of autoantibodies. Most thyroid conditions are autoimmune, and besides the thyroid hormone imbalances commonly present in Graves’ Disease and Hashimoto’s Thyroiditis, the autoimmune component of the condition is also a factor that can affect fertility.  One recent study showed that there was a high prevalence of infertility among women with Graves’ Disease and Hashimoto’s Thyroiditis (5), as this specific study showed that the prevalence of infertility was 52.3% in Graves’ Disease and 47% in Hashimoto’s Thyroiditis.  Some studies show that in female infertility there is a significantly higher prevalence of positive TPO antibodies when compared to controls (6).  Another study showed that during the first trimester pregnant women with autoimmune thyroid conditions carry a significantly increased risk for a miscarriage compared to women without thyroid autoimmunity, even when euthyroidism (normal thyroid hormone levels) was present before pregnancy (7).  A few other studies have shown an increased risk of miscarriage with thyroid autoimmunity (8) (9).

3. Problems with the adrenals/HPA axis. Obviously low progesterone can be a factor with infertility and frequent miscarriages.  But many people don’t make the connection between chronic stress and hormone imbalances, even though numerous studies have shown a connection between stress and infertility.    One of these studies revealed that the hypothalamic-pituitary-adrenal axis (HPA) has been shown to be an important mediator of infertility, and that the HPA axis affects the hypothalamic-pituitary-gonadotrophic (HPG) axis (10).  The study shows that changes in cortisol secretion due to chronic stress will affect the HPG axis, and can play a role in infertility.  Another one of these studies shows how glucocorticoids affect gonadal function at multiple levels at the HPG axis (11).  What’s important to understand is that chronic stress can lead to infertility, and it’s not necessarily the stress itself which causes the problem, but instead one’s perception of the stressors.  And so if someone is having problems with infertility, then they probably will want to incorporate certain mind body medicine techniques to help with this.  In fact, a few studies have shown how yoga and meditation can potentially help with infertility by improving the stress response (12) (13).

4. Mitochondrial dysfunction. Most people don’t think about the mitochondria when it comes to their fertility.  However, having healthy mitochondria is important when it comes to fertility.  In fact, the authors of a journal article I came across discussed a “fertility diet” to help improve mitochondrial function, which in turn can help to improve fertility (14).  Keep in mind that the mitochondria is where cholesterol becomes pregnenolone, and pregnenolone is the precursor to the sex hormones (progesterone, estradiol, testosterone, etc.), as well as a precursor to other hormones, such as cortisol.  As a result, if someone has a progesterone deficiency, it very well might be due to mitochondrial dysfunction.  One of the best methods of determining mitochondrial dysfunction is through an organic acids test, which is a urine test that looks at certain markers of the mitochondria, as well as other markers.  I have put together a separate post on the mitochondria entitled “The Relationship Between Mitochondria and Thyroid Health“.

5. Nutrient deficiencies. To no surprise, having nutrient deficiencies can affect fertility, both directly and indirectly.  Nutrient deficiencies can lead to some of the health issues I’ve discussed in this article (i.e. mitochondrial dysfunction), which can in turn cause infertility.  But a deficiency of certain nutrients can also affect fertility.  For example, in men the deficiencies of zinc and/or selenium can have a negative effect on sperm quality and cause infertility (15) (16) (17).

I’ve spoken about the importance of vitamin D in the past, but not specifically with regards to its importance in fertility.  A couple of recent reviews of the literature has determined that vitamin D is involved in many functions of the reproductive system in both men and women, as it might influence steroidogenesis of estradiol and progesterone in women, and can play a role in semen quality in men and increase testosterone levels (18) (19).  So this is yet another reason why you want to have healthy vitamin D levels.

6. Chronic infection. Having certain types of infections can increase the risk of infertility.  In fact, as I have discussed in previous articles and blog posts, one of the infections associated with autoimmune thyroid conditions is H. Pylori.  This is more common in those with Graves’ Disease, but I’ve seen some patients with Hashimoto’s Thyroiditis test positive for H. Pylori as well.  And there is evidence that having an H. Pylori infection can be a factor in infertility (20) (21) (22).  So if infertility is suspected then it probably would be a good idea to get tested for H. Pylori, and other infections might be a factor as well.

7. Environmental toxins. Not surprisingly, exposure to certain toxins can also decrease fertility.  For example, higher blood mercury concentration is associated with both male and female infertility (23).  The same source mentioned that higher seafood consumption is associated with elevated blood mercury concentrations, although keep in mind that testing for chronic exposure to mercury is more accurate in the hair and urine.  Another interesting study looked at the effects of mercury vapor on fertility of female dental assistants (24).  The study showed that women with high occupational exposure to mercury were less fertile than unexposed controls.  However, the study also showed that women with low exposure were actually more fertile than unexposed controls.  Either way, those who are dealing with infertility might want to get their mercury levels tested, perhaps using multiple sources.  There is evidence that other heavy metals might play a role in infertility, including lead and cadmium exposure (25) (26) (27) (28).

I’ve spoken about xenoestrogens in the past, and since these disrupt the endocrine system it shouldn’t be surprising that there is evidence showing that these toxins can affect fertility (29) (30).  Unfortunately xenoestrogens are widespread, as they are found in household cleaners and cosmetics, pesticides and herbicides, and of course in bottled water.  Although it’s impossible to eliminate one’s exposure to all of these toxins, one of course can do things to help minimize their exposure to toxins, and those couples who are thinking about conceiving will want to consider doing things to help with the detoxification of these chemicals prior to conceiving.

8. Genetically modified foods. As far as I know there is no proof that eating genetically modified foods can cause infertility in humans.  However, there is evidence of animals fed genetically modified crops showing complications such as early deliveries, abortions, and infertility (31).   Of course even if infertility isn’t an issue I think it’s a good idea to try your best to avoid genetically modified foods, which is difficult if you eat any type of refined foods or eat out, although it’s not impossible if you become an expert in reading ingredients and also are cautious about where you go out to eat, as well as what you consume.  For more information on genetically modified foods I’ve written an article entitled “The Impact of GMOs On Thyroid Health“.

9. Moderate alcohol consumption. Numerous studies show that moderate to high alcohol consumption can decrease fertility (32) (33).  Some may wonder whether drinking alcohol on occasion will cause problems, such as a glass of red wine each week, or a few alcoholic beverages per month.  I don’t know of any studies investigating this, but if someone is having difficulty getting pregnant it’s probably best to play it safe and avoid all alcohol.

10. Vigorous exercise. Obviously I’m not discouraging people from exercising, as doing so on a regular basis is important for optimal health.  However, it seems that exercising at a high intensity for a long duration (greater than one hour per day) will affect fertility (34) (35).  So while you want to exercise regularly, you don’t want to overexert yourself, and you definitely don’t want to exercise to the point of exhaustion.

11. Obesity/insulin resistance. There is plenty of evidence which shows a relationship between obesity and infertility in both women and men (36) (37) (38).  Most people who are obese also have insulin resistance, which is factor in the development of PCOS, another common cause of infertility.  I talk about PCOS in a different article entitled “Polycystic Ovarian Syndrome and Thyroid Health“.

12. Gluten and dairy consumption. There aren’t many studies about how common allergens such as gluten and dairy can affect fertility.  There are a few studies which show how Celiac disease may decrease fertility, and going on a gluten-free diet can help with this (39) (40).  As a result, if you have problems conceiving then it might be a good idea to get tested for Celiac disease, or to just avoid gluten altogether.  With regards to dairy, I only came across one “prospective study” which showed that high intake of low-fat dairy foods may increase the risk of anovulatory infertility, while the consumption of high-fat dairy products may decrease the risk (41).  I didn’t find any studies which showed a negative correlation between casein consumption and infertility.

13. Stevia. There is a little bit of controversy as to whether stevia can affect fertility.  One study conducted on male rats showed that chronic administration of stevia decreased male fertility (42).  However, remember that this involved “chronic administration”, and an earlier study conducted on male and female hamsters showed that when given stevioside (which is extracted from stevia leaves) there were no abnormalities in growth and fertility in both sexes (43).  To this date there haven’t been any studies showing whether consuming stevia affects fertility in humans, and while my guess is that having a small amount of stevia won’t cause problems, I could be wrong, and therefore if someone is having problems conceiving then it might be wise for the both the male and female to avoid stevia.

So What Can You Do To Overcome Infertility Naturally?

Anyone dealing with infertility will of course want to go through this list and consider each one of these factors as possibly causing or contributing to their infertility problem.  Some of these factors can be easily addressed, such as avoiding alcohol and not exercising too hard.  And of course you want to try following the basics, such as eating mostly whole foods while trying to minimize your consumption of refined foods, as well as not consuming artificial ingredients and genetically modified foods.  Managing your stress is always important, as is reducing your exposure to environmental toxins.

However, other factors can be challenging to address.  For example, if someone has mitochondrial dysfunction then this can be corrected, but it can be challenging to determine if someone has this problem.  And then if it is detected it will take time to correct this.  While one can minimize their exposure to toxins by eating organic food and buying natural cleaners and cosmetics, if they have a mouthful of mercury amalgams then this can be more challenging, as it can be very expensive to get these removed and replaced, and then one still will probably want to do some things to remove toxins from the tissues.  Plus, there is really no way to confirm that this is what’s causing the infertility, and so there is a chance that someone might spend thousands of dollars getting the mercury amalgams removed and replaced, and their fertility won’t improve.  Of course one can argue that getting these removed would be a good idea regardless of whether or not someone is dealing with infertility issues.

It’s also important to keep in mind that BOTH men and women need to do things to improve their health in order to improve the chances of conception.  After all, if a male is stressed out all of the time, is eating poorly, and/or is being exposed to a lot of toxins then this can very well affect his fertility.  So both the male and female need to commit to eating well, doing things to improve their stress handling skills, minimize their exposure to toxins, and if there is a health issue such as mitochondrial dysfunction or H. Pylori then these need to be addressed.

And of course the thyroid or autoimmune thyroid condition needs to be addressed as well.  Since both depressed and elevated thyroid hormone levels can be a factor in infertility, any thyroid imbalance needs to be corrected.  This might mean taking medication on a temporary or long term basis, or you might choose not to take medication and try to overcome your condition naturally.  If you have Hashimoto’s Thyroiditis or Graves’ Disease then you should work with a natural healthcare professional to help you suppress the autoimmune component, as this can be a factor in infertility.

It’s also worth mentioning that acupuncture might be able to help with some cases of infertility.  I briefly spoke about this in a previous blog post I wrote entitled “Can Acupuncture Benefit People With Thyroid Conditions?“.  And so before taking fertility drugs or spending thousands of dollars on IVF it probably would be worth receiving a few acupuncture treatments.

In summary, many men and women with autoimmune thyroid conditions have problems with fertility.  Many resort to treatment procedures such as IVF, and while this is something to consider in some cases, one should also look at other factors which can be causing the infertility.  Some of these causes include the thyroid hormone imbalance, the presence of autoantibodies, problems with the adrenals/HPA axis, mitochondrial dysfunction, obesity, nutrient deficiencies, environmental toxins, and even a chronic infection such as H. Pylori.  And before resorting to fertility drugs or IVF, those people looking for a more natural method of overcoming infertility might want to consider these factors I discussed.

Those people with hypothyroidism and Hashimoto’s Thyroiditis who have been reading my articles and blog posts for a long time probably realize that I’m not a big fan of thyroid hormone medication.  Most cases of hypothyroidism are caused by Hashimoto’s, which of course is an autoimmune thyroid condition which affects the thyroid gland.  So my goal with these patients is to try to restore the health of the immune system, and if at all possible get the person to the point where they don’t need to rely on synthetic or natural thyroid hormone.  And even with non-autoimmune hypothyroid conditions one should try to detect and correct the cause of the problem.  Since in most cases the thyroid gland itself isn’t the cause of the condition, I commonly will have patients, and even non-patients ask me if they can stop taking thyroid hormone medication, and just focus on the imbalances which are responsible for the hypothyroid condition.

Before you stop taking your thyroid hormone medication, you do need to understand the importance of thyroid hormone.  Although taking Synthroid, Tirosint, Armour, Nature-Throid, or any other type of synthetic or natural thyroid hormone isn’t doing anything for the cause of your condition, you still might need to take thyroid hormone while trying to address the cause of the problem.  While I can understand someone not wanting to take any type of medication, if someone has low or depressed thyroid hormone levels, not taking thyroid hormone medication can lead to serious health issues over time.

Understanding The Importance Of Thyroid Hormone

In the past I wrote an article entitled “Why Is Thyroid Hormone So Important To Our Health?”  In this article I discussed some of the more important functions of thyroid hormone, as it’s important for the metabolism of proteins, fats, and carbohydrates, regulates the expression of genes, plays an important role in brain development and function, is important for reproductive health and bone health, and also plays a role in wound healing and peripheral nerve regeneration.  So hopefully you realize that having low levels of thyroid hormone isn’t a good thing, and while I’m all for trying to restore someone’s health so they won’t need to take thyroid hormone medication, until they reach this point it might be a good idea to take thyroid hormone.  And of course there are people who will need to take thyroid hormone medication on a permanent basis.

Recently I attended a nutritional conference which focused on epigenetics, and one of the presenters spoke about the role of thyroid hormone in the mitochondria. Thyroid hormones, especially T3, are critical for the function of the mitochondria.  The mitochondria are located in the cytoplasm of our cells, and they are responsible for cellular respiration, and have many other functions.  Also, keep in mind that biosynthesis of the steroid hormones begin in the mitochondria, and so if someone has low levels of T3, this in turn can affect the production of steroid hormones such as estrogen, progesterone, and cortisol.  With regards to the mitochondria I’ve written a separate post you might want to check out entitled “The Relationship Between Mitochondria and Thyroid Health“.

Subclinical Hypothyroidism and Thyroid Hormone

Is it important to take thyroid hormone if someone has subclinical hypothyroidism?  So for example, if someone has an elevated TSH, but if their thyroid hormone levels are well within the lab reference range, does this person need to take thyroid hormone medication?  It really does depend on the situation, as if someone has an elevated TSH and both free T3 and free T4 are well within the functional reference range, and if they aren’t experiencing any symptoms, then they very well might not need to take synthetic or natural thyroid hormone.  On the other hand, if they are symptomatic then sometimes taking a small dose of thyroid hormone can help.  Plus, one does need to realize that there is a difference between the lab reference range and a functional reference range.

For example, for free T3 many labs use a normal reference range of 2.3-4.3 pg/mL.  If someone has a free T3 of 2.7 pg/mL this is considered to be normal, but it’s still on the low side.  So if someone has an elevated TSH, elevated thyroid antibodies, has a free T3 of 2.7 with minimal thyroid symptoms, should they go ahead and take thyroid hormone medication?  Of course most medical doctors would focus more on the TSH, and if the TSH is elevated they will usually recommend giving thyroid hormone medication, regardless of what the thyroid hormone levels look like.

In addition, even if someone has subclinical hypothyroidism, is completely asymptomatic, and isn’t taking thyroid hormone, they of course will still want to figure out what’s causing the problem.  Hashimoto’s Thyroiditis is the most common cause of subclinical hypothyroidism, as what happens is that the person will first develop elevated thyroid antibodies, which in turn will damage the thyroid gland.  However, it can take months, or sometimes even years for the TSH and thyroid hormone levels to be affected.  Unfortunately most medical doctors don’t screen for the thyroid antibodies unless if someone already has an elevated TSH, even though the thyroid antibodies are present well before the TSH rises.

Anyway, if someone has an elevated TSH and the free T3 and free T4 are both within the functional reference range, then the person very well might not need to take thyroid hormone medication.  But if they don’t do anything to address the cause then eventually they might need to take synthetic or natural thyroid hormone.  If someone is pregnant and has subclinical hypothyroidism, this is where it gets more challenging.  Thyroid hormone is of course very important for the developing fetus, and if a pregnant woman has an elevated TSH and elevated thyroid antibodies, yet her free T3 and free T4 are within the functional reference range, it still might be a good idea to take a small amount of thyroid hormone.  And the reason for this is because the person might currently have normal thyroid hormone levels, but then a few weeks or a few months later the levels might drop significantly, which can affect the health of the fetus.  Obviously someone with a thyroid imbalance will want to obtain a thyroid panel on a regular basis during pregnancy, but in many cases it’s a good idea for a pregnant women with subclinical hypothyroidism to take thyroid hormone medication, even if it’s a small dosage, just to be on the safe side.

Is There A Natural Substitute For Thyroid Hormone Medication?

I’m sure some people reading this will wonder if there is something else they can take instead of synthetic or natural thyroid hormone.  I’ll probably write a separate post on this in the future, but I will say that if someone has a thyroid hormone deficiency then there is no nutritional supplement or herb you can take in place of thyroid hormone.  There are herbs which in some cases can help to stimulate the production of thyroid hormone, but these don’t always work, and they usually aren’t a long term solution to the problem.  Of course if someone is deficient in a nutrient important for the formation of thyroid hormone such as iodine or tyrosine then this can help with the production of thyroid hormone.  However, while many people with hypothyroid conditions have nutrient deficiencies, most cases of hypothyroidism aren’t directly caused by these deficiencies.

How about thyroid glandulars?  Well, some thyroid glandulars do have small amounts of thyroid hormone, along with some nutrients and/or herbs (i.e. zinc, selenium, ashwagandha, coleus, etc.), and many people can take these instead of synthetic or natural thyroid hormone and do fine.  On the other hand, glandulars without thyroid hormone might provide some support to the thyroid gland, but once again, if someone has low or depressed thyroid hormone levels then this probably won’t be sufficient.  I commonly recommend a supplement called Thytrophin PMG, which supports the thyroid gland, but doesn’t contain thyroid hormone.  Although there are some people who will take this instead of thyroid hormone medication, it’s important to understand that it’s not a replacement for thyroid hormone.

In summary, although I’m not a big fan of thyroid hormone medication, this doesn’t mean that I recommend for people with hypothyroid conditions to stop taking synthetic or natural thyroid hormone.  Having normal thyroid hormone levels is very important, and so if someone has low or depressed thyroid hormone levels then it probably is a good idea for them to take thyroid hormone, while at the same time addressing the cause of the problem.  If someone has subclinical hypothyroidism then they might not need to take thyroid hormone medication, but it does depend on the situation.  And while there are some herbs and nutrients which can increase thyroid hormone production, there really isn’t a natural alternative for taking synthetic or natural thyroid hormone, although some people with hypothyroid conditions do fine on glandulars which contain thyroid hormone.

Life can be very challenging when dealing with a thyroid or autoimmune thyroid condition.  Although it’s not always easy to focus on the positive things in your life, most of us do have things to be grateful for.  When I was first diagnosed with Graves’ Disease I admittedly didn’t take this advice frequently, as initially I focused more on the negative factors than the positive things in my life.  But after awhile I realized that I needed to be grateful for the positive factors.

For example, while having an autoimmune thyroid condition truly stinks, there are other conditions which are much worse than either Graves’ Disease or Hashimoto’s Thyroiditis.  And so while I had a negative attitude when I was diagnosed with Graves’ Disease, I eventually became grateful for not having a health condition that was even worse, and once I began seeing the results of following a natural treatment protocol I of course was very grateful for this.  I was also grateful for having a supportive wife, and I’m still very grateful for this.  I’m extremely grateful for having two lovely daughters.  Even though I’m not as brave as I used to be when going on roller coasters, I’m grateful that I have a “roller coaster buddy” in my older daughter.

I’m of course very grateful for my wonderful patients, as well as those who aren’t my patients but take the time to read my articles and blog posts, attend my webinars, etc.  Thank you so much for your support, as I truly am grateful for it, and I hope you and your family have a wonderful Thanksgiving holiday.  And please make sure that you take a few minutes to reflect on what you’re grateful for.

The primary reason why people choose to follow a natural treatment protocol is to avoid the risks associated with conventional medicine.  Although there is a time and place for drugs, surgery, and other conventional treatment methods, these methods of course don’t do anything to address the cause of the problem.  However, not everyone who follows a natural treatment protocol will receive optimal results.  Many times this is due to the patient not being compliant, although some will do an excellent job of following the doctor’s recommendations and still won’t show much improvement.

When this happens it becomes frustrating to both the doctor and patient.  Some doctors take pride in dealing with “tough cases”, and although I do work with a lot of tough cases, I think most doctors would prefer those cases when someone gradually improves without any setbacks.  Don’t get me wrong, as I like dealing with challenges, and many cases of thyroid autoimmunity can be complex.  However, I still get frustrated when someone is strictly following my recommendations but doesn’t receive optimal results.  There can be numerous reasons why someone doesn’t receive optimal results despite following the recommendations of their doctor, but when this happens it usually comes down to one or more of the following five factors:

1. The patient is reacting to a food allergen or antinutrient. If someone’s health isn’t improving then one of the first things they need to do is reevaluate their diet, as there is a good chance one or more food allergens or antinutrients are responsible for the person not progressing.  This can occur even if the person is eating a healthy diet.  Many people reading this are aware that gluten and dairy are common allergens, and thus if someone has been consuming gluten and/or dairy while following a natural treatment protocol and aren’t receiving optimal results, then these allergens definitely need to be COMPLETELY avoided.  This is true even if you haven’t noticed any negative symptoms upon consuming gluten and dairy.  And yes, even if you have received testing which showed that you didn’t react to these foods you still want to cut them out.

There are times when I’m working with someone who isn’t progressing as expected, and they have been strict about avoiding gluten and dairy.  Many times they have  avoided these allergens for a few months or longer.  If this is the case then they need to look at the possibility of other foods causing a negative reaction, such as corn, soy, eggs, and even gluten-free grains.  For example, someone might have eliminated gluten, dairy, corn, and soy, but after doing an elimination diet find out they have a sensitivity to rice.  And if they were consuming rice, even a few times per week, then this can cause gut inflammation and affect their recovery.  Obviously this is just an example, but it of course is possible to have a negative reaction to rice, as well as other gluten free grains.

If someone has a leaky gut, then eating nuts, seeds, and legumes can slow down their progress.  This usually isn’t due to a food intolerance, as these all have antinutrients which interfere with the absorption of minerals.  In addition, antinutrients such as lectins can cause further damage to the gut.  And so if someone has avoided all of the common allergens, but is still eating nuts, seeds, and/or legumes, then this can affect one’s recovery.  Some people also react to the nightshade family of foods.  These include tomatoes, eggplant, white potatoes, and most peppers.  These also have substances which can cause a leaky gut.

How can someone tell if they have a food allergy or intolerance?  It can be challenging to tell if someone has a food allergy or intolerance.  As for a food allergy, this can be detected through IgE testing, and is usually conducted in an allergist’s office.  Besides the fact that IgE testing isn’t always accurate (1) (2), delayed food intolerances are far more common.  And while there are numerous food intolerance panels available, none of these are completely accurate either.  This doesn’t mean that they don’t have some value, but false negatives are common, and if someone has a leaky gut this can also affect the results.

2. There is an underlying infection. If someone has ruled out food allergies and intolerances as a potential cause of their problem, and have eliminated the antinutrients I mentioned, then they will want to try to see if they have some type of infection.  Some healthcare professionals will initially do testing for infections, as a lot of functional medicine doctors will run a comprehensive stool panel to see if there are any bacterial infections, yeast, or parasites.  Although I do run a comprehensive stool panel every now and then, I don’t initially do this testing on all of my patients because 1) they are very expensive, and 2) they almost always come out negative for the presence of pathogenic bacteria, yeast, and parasites.  Sure, the test might reveal gut inflammation, or a deficiency of short chain fatty acids, but I usually assume that most of my patients have gut inflammation, and while it’s also common to have an imbalance of the short chain fatty acids, in my opinion it’s not worth a few hundred dollars to test for this.

I’m not being critical of those doctors who do this type of testing on all of their patients.  Quite frankly, it probably is a good idea to do such testing on someone who has obvious gastrointestinal symptoms.  The problem is that the lack of gastrointestinal symptoms doesn’t mean that the person doesn’t have pathogens in the gut, which is why some healthcare professionals choose to have all of their patients obtain this test.  On the other hand, a negative test for pathogens doesn’t necessarily mean the person doesn’t have an infection.  For example, I’ve had patients with symptoms of a yeast infection test negative for such an infection on a stool panel, and then not too long after this have a  test for yeast show up positive on a blood or urine test.  Similarly, parasites aren’t always detected in the stool.  In fact, this is the main reason why many labs will offer a 3 or 4-sample stool test.  Collecting a stool sample on three or four different days will reduce the likelihood of a false negative, although false negatives still remain a possibility, even with testing multiple stool samples on different days.

Plus, most comprehensive stool panels won’t test for all of the pathogens which can be detected in the stool.  For example, many labs offer both H. Pylori and C. difficile as “add-ons”, and other bacteria might need to be added as well.  This of course means that it can cost a lot more money if you want to test for everything the lab offers. In addition, one also needs to keep in mind that not all chronic infections can be detected in the stool.  Some examples include Lyme disease, Epstein Barr, and Cytomegalovirus.  It would be great if there was a lab which offered a comprehensive panel for infections which included both blood and stool testing, and tested for most of the common pathogenic bacteria, viruses, fungi, and parasites.

So that brings up the question, “is there a surefire method for detecting a chronic infection?”.  Unfortunately the answer to this question is “no”.  And so there are a few options.  One option is to do as much testing as possible, including blood tests and stool testing.  The problem is that if you don’t have health insurance then doing all of this will be very expensive, and this still might not completely rule out an infection.  What approach do I take?  Well, I think it’s a good idea to start with the basics, such as a complete blood count with differential.  This of course won’t determine if someone has a specific infection, but it sometimes can give an idea if someone is having an acute or chronic bacterial or viral infection, and sometimes even a parasitic infection if the eosinophils are elevated.  If this test reveals a potential infection then I will consider further testing.  If someone has overt gastrointestinal symptoms then I might do a stool panel, although I’m well aware of the limitations I mentioned above.  If I think there’s a strong possibility someone has an infection I might just put them on a dysbiosis protocol and see how they respond.  Or I might run an organic acids test, which looks at certain markers of dysbiosis.

3. Chronic stress is an issue. I probably should have listed this first, as stress is a common reason why many people don’t progress as expected.  Although some healthcare professionals might frequently use chronic stress as an excuse for a person’s symptoms or lack of progress, the truth is that chronic stress does affect the biochemistry.  In other words, the emotional component of stress can have a dramatic effect on someone’s health.  And for someone who is dealing with a thyroid or autoimmune thyroid condition, the fact that they have a chronic health condition only increases their stress levels.  It’s not so much the stress itself that is a problem, as everyone deals with acute and chronic stressors.  What’s important is the person’s perception of the stressor, and it’s essential for people with thyroid and autoimmune thyroid conditions to truly become an expert in handling stress if they want to restore their health, and maintain their health thereafter.

In fact, I’ve had some patients get to the point where they were symptom free and all of the labs were negative, but then a very stressful situation came along, and they relapsed.  This might sound discouraging to some people reading this, as you might be thinking to yourself “why would I want to follow a natural treatment protocol if there’s a chance that being exposed to a stressor will result in a relapse?”  After all, everyone will eventually have to deal with an acute or chronic stressor such as financial problems, a divorce, a trauma, the loss of their job, a death of a family member or close friend, etc.  While it’s just about impossible to prepare for all of the different stressors you will eventually have to deal with, if you become an expert in managing the stress then you will do a much better job of handling these future stressors.

It really is no different than eating well, as while some people are able to change their eating habits in one day, for others it takes time to accomplish this.  Some people need to make gradual changes in their diet over a number of weeks or months before they are eating mostly whole foods, and minimizing their consumption of refined foods and sugars.  The same concept applies when it comes to improving your stress handling skills, as it takes time to become an expert in managing stress.  Truth to be told, I still don’t consider myself to be an “expert” when it comes to stress handling, although I’ve made some great strides over the years.  If stress is an issue, you need to make stress management a priority if you want to receive good results. And the only way to truly become a master at handling stress is to block out some time every day to work on stress management.  I discussed this in greater detail in my blog post entitled “Blocking Out Time To Manage Your Stress Is Essential“.

4. Genetic polymorphisms. Although lifestyle and environmental factors seem to play a greater role than genetics in the development of most chronic health conditions, one still can’t dismiss the genetic component.  And when someone isn’t responding as expected to a natural treatment protocol, there is a possibility that a genetic polymorphism is the reason behind this.  A genetic polymorphism is a genetic defect that commonly affects a certain percentage of the population.

Having certain genetic polymorphisms can affect phase 1 and phase 2 detoxification, the immune system response, the metabolism of folate, vitamin and hormone receptors, and even DNA repair enzymes.  So for example, a toxin such as mercury might have triggered an autoimmune response in a person with a polymorphism affecting the detoxification pathways.  This person might have received months of chelation therapy, but still hasn’t noticed an improvement in their symptoms because their body isn’t doing a good job of eliminating the mercury due to the genetic polymorphism, which in turn is affecting the detoxification pathways.

I also mentioned how certain genetic polymorphisms can affect the immune system response.  Proinflammatory cytokines are a factor in autoimmunity, and someone can have genetic polymorphisms of these cytokines.  I’ve spoken about the Th1 and Th2 pathways in past articles and blog posts, and you can have polymorphisms of Th1 cytokines such as IL-2 and TGF-B1, and Th2 cytokines such as IL-6 and IL-10 (3).  So if someone isn’t responding then it’s possible that they have one or more polymorphisms which are affecting their progress.

But how can someone tell if they have certain genetic polymorphisms?  Testing is available for the more common polymorphisms.  For example, many people reading this are familiar with the MTHFR polymorphism, and many labs offer testing for this.  The company Genova/Metametrix offers testing for certain polymorphisms.  For example, they have an “ImmunoGenomic Profile”, which will measure some of the Th1 and Th2 cytokines such as TNF-alpha, IL-4, IL-6, IL-10, etc.  They also have a “DetoxiGenomic Profile”, which tests for a few dozen of the most common polymorphisms relating to detoxification.  I can’t say I routinely do this type of testing on my patients, but it’s something to consider if someone isn’t responding as expected.

5. Toxic overload. Many of my patients initially will do things for detoxification.  However, while this of course is beneficial, many times the person needs to be more aggressive in eliminating toxins from their body.  First of all, we need to keep in mind that different people are exposed to a different amount of toxins.  And while there are some tests available to measure the levels of certain toxins, it’s impossible to measure ALL of the different toxins.  So for example, if someone obtains a hair analysis or a urine test to look at heavy metals, and if such testing reveals low levels of mercury, arsenic, and other toxic metals, this doesn’t necessary mean that they have low levels of other types of toxins.

A second factor to consider is that some people eliminate toxins better than others.  As a result, if two people are exposed to the same level of toxins, one person might do a very good job of eliminating  toxins, while the other person might not do a good job of eliminating toxins.  There can be a few reasons for this.  One reason could be that one person has higher levels of glutathione, which plays an important role in the detoxification pathways.  Genetics can also be a factor.  As I mentioned earlier, if someone has a certain genetic polymorphism then they might not be able to eliminate toxins as efficiently as another person, and this also can be related to glutathione production.

A third factor to consider is that people react differently to toxins. So for example, one person might have a severe reaction to a small amount of a specific toxin, while another person might not react to a large amount of the same toxin.  In the past I’ve mentioned the Chemical Immune Reactivity Screen from Cyrex Labs.  Although I admit this isn’t a test I commonly order, it’s a very interesting test, as it measures the immune system response to some of the more common toxins, such as mercury, arsenic, lead, formaldehyde, bisphenol A, parabens, and isocyanate.

In any case, if someone follows a natural treatment protocol recommended by their doctor and still isn’t receiving optimal results, toxins need to be considered.  And it’s also important to keep in mind that some people have more than one health issue going on simultaneously.  For example, it’s common for people with Graves’ Disease and Hashimoto’s Thyroiditis to have a leaky gut, along with intestinal dysbiosis.  However, their bodily tissues might also be overloaded with toxins.  And so when someone has a leaky gut I will focus on repairing the gut and correcting any dysbiosis.  Once the gut has been healed and the dysbiosis has been corrected, if the person is still symptomatic and/or still has elevated thyroid antibodies, then toxins need to be considered.  Although I might give some recommendations to help the person boost glutathione levels while repairing the gut, this might not be sufficient.

In some of my past articles and blog posts I’ve mentioned Dr. Walter Crinnion, as he is a naturopath who focuses on detoxification.  He has been in practice for around 30 years, and while I was working towards my masters of science in nutrition degree he was the instructor for my biotransformation and detoxification course.  He is a big proponent of both sauna therapy and colon hydrotherapy.  In fact, he said if he had to choose one method of detoxification it would be colon hydrotherapy.  Although colon hydrotherapy can be very effective in removing toxins, the problem is that you don’t want to receive colon hydrotherapy if you have a leaky gut.  And so you first need to correct the leaky gut, and then if necessary receive colon hydrotherapy.  While I personally don’t recommend colon hydrotherapy to most of my patients, it can be an excellent method of eliminating toxins.

Even if you get aggressive and utilize a combination of supplements (i.e. milk thistle, NAC, etc.), sauna therapy, and colon hydrotherapy to eliminate toxins, it can still take many months to notice results.  In his book Clean, Green, and Lean Dr. Crinnion talks about how he commonly sees the autoantibodies of patients normalize after putting them on a comprehensive program to eliminate toxins.  The downside is that this does take time, and even he admits that for some people it can take a couple of years before they receive optimal benefits from a detoxification program.

In summary, it can be frustrating when someone is strictly following the recommendations of their doctor, yet for some reason isn’t progressing as expected.  There are numerous reasons why someone’s health doesn’t improve, but five common factors include 1) the person is reacting to a food allergen or antinutrient, 2) there is an underlying infection, 3) chronic stress is an issue, 4) they have one or more genetic polymorphisms, and 5) toxic overload.  It can be challenging to find out which of these factors is responsible for the patient’s lack of progress, but doing so is of course necessary to help them restore their health.

More and more people are working with natural healthcare professionals.  And it’s becoming more common for people to see more than one natural healthcare professional.  For example, someone might see a chiropractor to receive spinal adjustments, get deep tissue massages from a licensed massage therapist on a regular basis, see a biological dentist for their oral health, etc.  And of course there is acupuncture.  Over the years I have had many people with thyroid and autoimmune thyroid conditions ask me if acupuncture can benefit their health, which is why I decided to write this blog post.

Before talking about whether or not acupuncture can help with thyroid and autoimmune thyroid conditions, let’s first discuss some of the basics of acupuncture.   As most people reading this know, acupuncture involves using fine needles which are inserted at specific locations of the body, which are known as acupuncture points (1).  These points are linked together in a network of “meridians”, which run longitudinally along the surface of the body (1).  There are 20 meridians, and 12 of these are referred to as “primary meridians”, and these relate to specific organs (2).  There is also something called “Qi”, which is probably best described as an energy that flows through the meridians, and as described by Dr. Yin Lo in an article he wrote in Acupuncture Today, “Qi is what carries the effect of acupuncture from one acupoint to other parts of the body” (3).

Acupuncture affects all of the systems of the body, including the immune system, gastrointestinal tract, and the endocrine system.  It helps to promote blood flow (4), stimulates the release of neurotransmitters and endorphins which help to decrease pain (5), helps to reduce stress (6), and as I’ll mention later in this post, it can modulate the immune system.

What Are The Benefits of Receiving Acupuncture?

There are many different benefits of acupuncture.  And if you search through the literature you’ll see many studies which show that acupuncture can help people with a wide range of different health conditions.  Here are just a few conditions acupuncture might be able to help with:

Acute and chronic pain. There are many different studies which show that acupuncture can benefit people with chronic pain.  One systematic review compared the effectiveness of acupuncture with other treatment methods for alleviating pain due to osteoarthritis of the knee (7).  This review involved 114 trials and 9,709 patients, and they concluded that acupuncture can be considered to be one of the more effective physical treatments for alleviating osteoarthritis knee pain in the short term.  However, the authors did admit that a lot of the evidence is still of poor quality, and therefore more research is probably needed in this area.  There is also is evidence that acupuncture can be more effective than medication for pain relief for both acute and chronic low back pain (8) (9).  Randomized controlled trials have shown that acupuncture has short-term effectiveness in the treatment of neck pain (10).

Infertility and polycystic ovarian syndrome (PCOS). Acupuncture can help with some cases of female infertility (11) (12). With regards to PCOS, a literature review in 2010 showed that acupuncture may help people with PCOS by increasing blood flow to the ovaries, reducing ovarian volume and the number of ovarian cysts, increasing insulin sensitivity and reducing cortisol levels (13).  A recent randomized controlled trial involving 32 women with PCOS showed that repeated acupuncture treatments resulted in higher ovulation frequency, and that ovarian and adrenal sex steroid serum levels were reduced with no effect on LH secretion (14).

Asthma. One randomized controlled study showed that acupuncture performed in accordance with the principles of traditional Chinese Medicine showed significant immune-modulating effects and that asthma patients can benefit from acupuncture treatment (15).  However, there are other studies which don’t show benefits of acupuncture in the management of certain cases of asthma (16).

Cancer patients receiving chemotherapy. I came across one study involving 45 patients with cancer who had acupuncture administered one day prior to them receiving chemotherapy (17).  The study showed that acupuncture can have positive effects in cancer treatment patients who experience nausea, vomiting, pain, insomnia, and anxiety as a side effect of chemotherapy.  And so while I’m not a big fan of chemotherapy, those who do receive this might want to consider getting one or more acupuncture treatments beforehand.

Migraines. There have been numerous studies showing that acupuncture can benefit some people with migraines, although there also have been studies which have shown that acupuncture doesn’t have a greater effect than sham acupuncture.  A randomized controlled trial involving 175 patients with migraines showed that verum acupuncture is more effective than sham acupuncture in reducing the discomfort of an acute migraine, as well as in preventing migraine relapse or aggravation (18). Another randomized controlled trial involving 480 patients with migraines showed that acupuncture had a clinically minor effect on migraine relief compared with sham acupuncture (19).  A few other studies showed that acupuncture was no more effective than sham acupuncture in reducing migraine headaches (20) (21).

Acupuncture and Thyroid Health

There aren’t a lot of clinical trials involving acupuncture and thyroid health, although I did come across a few of them:

Acupuncture and Subclinical Hypothyroidism. One study looked at the influence of acupuncture on the quality of life in patients with subclinical hypothyroidism (22).  The study involved 27 female patients who were found to have elevated TSH levels, along with normal levels of thyroid hormones.  Twenty of the 27 patients who underwent the treatment showed a significant decrease in the severity of clinical symptoms, and the TSH levels fell down to the physiological values.  The study concluded that acupuncture may be regarded as an alternative to substitution therapy of subclinical hypothyroidism.  Of course this is just a single study involving only 27 people, and without question more research needs to be done on this.  With that being said, the results still were encouraging, and it might be worth for some people with subclinical hypothyroidism to see an acupuncturist.  Plus, remember that most people with subclinical hypothyroidism have Hashimoto’s Thyroiditis, and the improvement in these patients might suggest that receiving the acupuncture treatments modulated the immune system, which I’ll discuss shortly.

Acupuncture and Thyroid Eye Disease. One study compared the therapeutic effect and side effects on hyperthyroid exophthalmos with the combination of acupuncture and medication, and with medication only (23).  It involved fifty two cases, and it showed that the improvement of thyroid eye disease was better in the acupuncture and medication group than in the medication group alone. Hyperthyroid exophthalmos is typically due to the TSH receptor antibodies attacking the tissues of the eye, and so this also suggests that acupuncture might modulate the immune system, in this case benefiting people with Graves’ Disease.

Acupuncture and benign thyroid nodules. This study involved 46 patients with thyroid adenoma who were treated by electrochemical treatment during acupuncture anesthesia (24).  After three months to four years follow up the cure rate was 97.8%.  In addition to this being another small study, it was conducted in 1994, and so it would be nice to see larger, more current studies.

Acupuncture and autoimmunity. I did not come across any specific studies which showed that acupuncture can help with Graves’ disease or Hashimoto’s Thyroiditis.  However, acupuncture can modulate the immune system (25) (26), and thus it potentially can benefit people with immunological conditions such as those with allergies, infections, immunodeficiency syndromes, and autoimmune conditions.

Of course the lack of clinical trials related to thyroid health doesn’t mean that acupuncture can’t be beneficial for those with thyroid and autoimmune thyroid conditions.  I’ve had numerous patients see an acupuncturist and report back a positive improvement in their condition.  One thing to keep in mind is that while acupuncture might benefit people with autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis by modulating the immune system, in most cases it won’t do anything to address the trigger.  For example, if someone has a leaky gut due to a gluten intolerance or an H. Pylori infection, receiving acupuncture probably isn’t going to heal the leaky gut, and most likely wouldn’t eradicate the H. Pylori infection (although by modulating the immune system it might improve the chances of eradicating H. Pylori when combined with other methods).  With that being said, acupuncture when used in combination with other natural treatment methods can potentially benefit those people with thyroid and autoimmune thyroid conditions.

In summary, acupuncture involves acupoints and meridians, which relate to specific organs.  Qi is an energy that flows through the meridians, and carries the effect of acupuncture from one acupoint to other parts of the body.  Acupuncture can help people with many different conditions, including those with acute and chronic pain, infertility, PCOS, asthma, patients receiving chemotherapy, migraines, and other conditions.  There are a few small studies which show that acupuncture can benefit thyroid health, probably by modulating the immune system in those people with Graves’ Disease and Hashimoto’s Thyroiditis.  And while acupuncture alone usually won’t restore someone’s health back to normal, many people with thyroid and autoimmune thyroid conditions can benefit from receiving acupuncture when combined with other natural treatment methods.